Exercise allergies can be linked to food

In terms of timing, there is evidence that otherwise nonallergic foods consumed as far as 24 hours in advance of exercise could be a potential trigger for FDEIA.Photo by
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Is it possible to be allergic to exercise? While the question might evoke clichéd images of pimply kids rebelling against phys. ed. teachers in bad track suits, rest assured this bizarre-sounding concept is not made up. I can speak to this first-hand: In my early twenties, I started to experience strange, but very intense allergic reactions that always seemed to occur when I ate too soon before exercise. After a few hospital visits and much research, I realized that certain foods, and even outdoor temperature, can trigger an allergic response for me when I exercise.

Last week, we looked at the nutritional implications of a less-than-common type of allergy known as oral allergy syndrome; this week, we'll examine a relatively rare, but occasionally dangerous condition triggered by the combination of food and exercise in certain individuals.

What is it?

It might be a mouthful to say, but Food-Dependent Exercise-Induced Anaphylaxis (FDEIA) can be a serious, and potentially life-threatening condition. Like other allergic reactions, such as generalized anaphylaxis or oral allergy syndrome, FDEIA is triggered by an immune system response, mediated by a compound known as immunoglobulin E, or IgE. In affected individuals, FDEIA can occur when a particular food is eaten before, or in rare cases shortly after, the physical stress of exercise. The twist, however, is that while the given food -- shellfish, wheat, and various fruits and vegetables are common triggers -might not cause an allergic response in day-to-day life, it can be the catalyst for a severe allergic reaction when mixed with exercise. This can leave affected individuals feeling a little lost and confused when it comes to determining the cause of their seemingly out-of-the-blue reaction.

Physically, FDEIA can manifest as itchiness, hives, generalized swelling, difficulty swallowing, and/or a drop in blood pressure, among other symptoms. While researchers have acknowledged the condition since the mid-1980s, it remains relatively uncommon, even among the food allergy sufferers. A study published in the Journal of Investigative Allergology and Clinical Immunology earlier this year found that, of all of the cases of anaphylaxis reported in the emergency department, FDEIA was identified in a mere 2.4% of cases (anaphylaxis to food, by comparison, occurred in 29% of cases). Since many individuals may not be aware their symptoms are actually FDEIA, the actual incidence rates could be higher.

Is it the same thing as exercise-induced anaphylaxis?

The difference between FDEIA and more common Exercise-Induced Anaphylaxis (EIA) is simply the presence of a food-based trigger. Otherwise, EIA can occur in individuals exercising at a moderate to high intensity, but the causes are much more difficult to pinpoint.

In terms of timing, there is evidence that otherwise nonallergic foods consumed as far as 24 hours in advance of exercise could be a potential trigger for FDEIA. While there seems to be no link between race or ethnicity and risk of FDEIA, there is some evidence that peanuts, tomatoes and cereals are more common triggers for those of European descent, while wheat seems to be a prevalent trigger in Japanese populations.

How can I manage FDEIA?

The best treatment for FDEIA is to identify known trigger foods, and avoid consuming them before, and ideally after exercise as well. If the trigger food is not known, then it is often recommended that all eating be avoided for four to six hours before exercise. Unfortunately, this can leave an individual feeling hungry and tired by the time they start exercising, reducing both the potential benefits from and the enjoyment of exercise. For this reason, it is helpful to identify known "safe" foods before exercise, and consume them whenever possible.

Beyond food elimination, there is also some evidence that symptoms can potentially be prevented by taking allergy medications (preferably nondrowsy) before exercise. Inhaled corticosteroids (asthma inhalers) can also be beneficial. Of course, if any symptoms appear during exercise, the activity should be stopped immediately.

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